Development and use of a population based injury surveillance system: the all Wales Injury Surveillance System (AWISS)

Evaluation of first information reports of Delhi police for injury surveillance: Data extraction tool development & validation

Background & objectives:

Policymakers and health professionals need to know the distribution, patterns, trends and risk factors of injury occurrence to develop strategies that reduce the incidence of injuries. The first information report (FIR) of Indian police is one potential source of this information. The aims of this study were to identify the minimum data set (MDS) recommended for injury surveillance, to develop a tool for data extraction from FIRs, to evaluate whether FIRs contain this MDS and to assess the inter-rater reliability of the tool.

Methods:

This was a cross-sectional study of incidents reported to Delhi Police in 2017. A systematic literature search was conducted to identify the MDS recommended for injury surveillance. A tool was designed for extraction of data, and its inter-rater reliability was assessed using Cohen's kappa and the percentage availability of each MDS data item in the FIRs, was calculated.

Results:

The literature review identified 24 reports that recommended 12 MDS for injury surveillance. The FIRs contained complete information on the following five MDS: sex/gender (100%), date of injury (100%), time of injury (100%), place of injurious event (100%) and intent (100%). For the following seven MDS, information was not complete: name (93.1%), age (67.2%), occupation (32.8%), residence (86.2%), activity of the injured person (86.2%), cause of the injury (93.1%) and nature of the injury (41.4%). The inter-rater reliability of the data extraction tool was found to be almost perfect.

Interpretation & conclusions:

Information on injuries can be reliably extracted from FIRs. Although FIRs do not always contain complete information on the MDS, if missing data are imputed, these could form the basis of an injury surveillance system. However, use of FIRs for injury surveillance could be limited by the representativeness of injuries ascertained by FIRs to the population. FIRs thus have the potential to become an important component of an integrated injury surveillance system.

Non-fatal injuries treated outside a hospital in Hunan, China: results from a household interview survey

Background: Injury morbidity data are collected through hospital-based surveillance in many countries. We assessed the extent of non-fatal injures treated outside a hospital. Methods: Data from the first provincial health household interview survey of Hunan, China, conducted in 2013, were used. Injury events were identified and included as medically significant when any of the following circumstances occurred in the prior 14 days: (i) receiving medical treatment from a doctor at a hospital following an injury; (ii) receiving medical treatment by self or others outside a hospital following an injury (e.g. taking medications, or receiving massage or hot compress); and/or (iii) being off work or school, or in bed for more than 1 day, following an injury. The 2-week prevalence of non-fatal injuries and 95% confidence intervals were calculated. We calculated the proportion of injury events treated outside a hospital and the reasons for not visiting a hospital for injury events occurring during the previous 2 weeks. Results: We captured 56 injury events during the previous 2 weeks. The weighted injury prevalence was 4.9 per 1000 persons during the last 2 weeks (95% confidence interval: 2.9–6.9 per 1000 persons). Of the 56 events, 14 (weighted proportion 41.2%) were treated outside a hospital. Primary explanations for skipping hospital visits included perceiving injuries were too minor and economic limitations to travel to hospitals or seek treatment. Conclusion: Results imply the burden of non-fatal injury may be underestimated by hospital-based surveillance systems such as that used in China.

All Wales Injury Surveillance System revised: development of a population-based system to evaluate single-level and multilevel interventions

Background

Injury surveillance has been established since the 1990s, but is still largely based upon single-source data from sentinel sites. The growth of electronic health records and developments in privacy protecting linkage technologies provide an opportunity for more sophisticated surveillance systems.

Objective

To describe the evolution of an injury surveillance system to support the evaluation of interventions, both simple and complex in terms of organisation.

Methods

The paper describes the evolution of the system from one that relied upon data only from emergency departments to one that include multisource data and are now embedded in a total population privacy protecting data linkage system. Injury incidence estimates are compared by source and data linkage used to aid understanding of data quality issues. Examples of applications, challenges and solutions are described.

Results

The age profile and estimated incidence of injuries recorded in general practice, emergency departments and hospital admissions differ considerably. Data linkage has enabled the evaluation of complex interventions and measurement of longer-term impact of a wide range of exposures.

Conclusions

Embedding injury surveillance within privacy protecting data linkage environment can transform the utility of a traditional single-source surveillance system to a multisource system. It also facilitates greater involvement in the evaluation of simple and complex healthcare and non-healthcare interventions and contributes to the growing evidence basis underlying the science of injury prevention and control.

The WHO injury surveillance guidelines: a systematic review of the non-fatal guidelines' utilization, efficacy and effectiveness

OBJECTIVES

To systematically assess the utilization, efficacy and effectiveness of the WHO Injury Surveillance Guidelines.

STUDY DESIGN

A systematic review of the literature.

METHODS

A comprehensive systematic search of peer reviewed and grey literature was conducted for relevant studies published between Jan 2002 and May 2013 reporting utilization of the Injury Surveillance Guidelines. Injury experts and government departments from low- and middle-income countries were contacted.

RESULTS

Forty-nine studies met the inclusion criteria. These were conducted in health facilities in five WHO regions, African Region (28%): Eastern Mediterranean and Western Pacific Regions, both 22%. The Guidelines were mostly used selectively: the minimum data set as a survey tool; process and system environment evaluation; categorizing injuries for data analysis; measuring injury severity and for data quality assessment or comparisons. Twenty-six studies used the Guidelines to collect overview injury data prospectively and/or retrospectively, or for Injury Surveillance System (ISS) feasibility studies, with four actually establishing an ISS or informing the establishment process. Few reported effects on injury policies and programs. Most studies used only the minimum dataset, limiting the level of detail for injury prevention. Other ISSs may have been established using the Guidelines, though no English language publications referencing this were found.

CONCLUSIONS

This review provides encouraging results that the Guidelines continue to be used, albeit mainly for short-term studies predominantly in low- and middle-income countries with very limited sustained ISS establishment and local injury prevention capacity building. It highlights the need to improve and expand the minimum dataset to at least include a meaningful narrative text and potentially to expand the mechanism codes to a second level of detail, as well as building local injury prevention capacity.

Is the introduction of violence and injury observatories associated with a reduction of violence in adult populations? Rationale and protocol for a systematic review

INTRODUCTION

The violence and injury observatories developed in Colombia and found throughout the Americas and Western Europe aim to maximise inter-institutional cooperation, information-sharing, analysis and security policy development initiatives to enhance governance. The purpose of the violence and injury observatories is directed towards preventing crime and violence at the local and regional levels. To date, there has been no systematic review of the literature to present a succinct review of the evidence. We therefore sought to summarise the evidence from existing studies on the contribution of violence and injury observatories towards violence prevention.

METHODS AND ANALYSIS

A number of databases will be searched, supplemented by the same keyword searches in the grey literature. Search terms will include studies published from 1 January 1990 to 30 October 2014. Study quality will be assessed using a validated quality assessment tool. Two researchers will independently assess articles for study eligibility to reduce bias, minimise errors and enhance the reliability of findings. Disagreements will be resolved by consensus among three authors. This review protocol has been published in the PROSPERO International Prospective Register of systematic reviews, registration number 2014:CRD42014009818.

DISSEMINATION

There is a paucity of evidence for the effectiveness of violence and injury observatories and their influence on violence in an adult population. We plan to address this gap in knowledge by way of a systematic review and meta-analysis outlined in this abstract. We anticipate that the results could be used by researchers and policymakers to help inform them of the efficacy of violence and injury observatories and their broader role in contributing to violence prevention.

TRIAL REGISTRATION NUMBER

CRD42014009818.

Childhood injury in Tower Hamlets: Audit of children presenting with injury to an inner city A&E department in London

INTRODUCTION

Childhood injury is a leading cause of mortality and morbidity worldwide with the most socio-economically deprived children at greatest risk. Current routine NHS hospital data collection in England is inadequate to inform or evaluate prevention strategies. A pilot study of enhanced data collection was conducted to assess the feasibility of collecting accident and emergency data for national injury surveillance.

AIMS

To evaluate the reliability and feasibility of supplementary data collection using a paper-based questionnaire and to assess the potential relationship between income deprivation and incidence of paediatric injury.

METHODS

Clinical staff conducted an audit of injuries in all patients under 16 years between June and December 2012 through completion of a questionnaire while taking the medical history. Descriptive statistics were produced for age, sex, time of arrival, activity at time of injury, mechanism and location of injuries. The association between known injury incidence and area level income deprivation (2010 English Index of Multiple Deprivation [IMD] Income Deprivation Domain from home postcode) was assessed using Spearman's rank correlation. Representativeness of the audit was measured using z-test statistics for time of arrival, age, sex and ethnicity.

RESULTS

The paper audit captured 414 (6.5%) of the 6358 under-16 injury-related attendances recorded on the NHS Care Record Service Dataset. Comparison of the audit dataset with NHS records showed that the audit was not representative of the larger dataset except for sex of the patient. There was a positive correlation between injury incidence and income deprivation measured using IMD score where data were available (n = 384, p < 0.001). Nearly half of the attendances were due to falls, slips or trips (49.8%) and more than half were due to either leisure (32.9%) or sport (18.1%) activities.

CONCLUSION

There is evidence of area level income inequalities in injury incidence among children attending the Royal London Hospital. The audit failed to capture a high proportion of cases, likely due to the paper-based format used. This study highlights the importance of routinely collecting enhanced injury data in computerized hospital admission systems to provide the necessary evidence base for effective injury prevention. The findings have contributed to plans for implementation.

Development and piloting of the Fiji Injury Surveillance in Hospitals System (TRIP Project-1)

INTRODUCTION

Whilst more than 90% of injury related deaths are estimated to occur in low-and-middle-income countries (LMICs), the epidemiology of fatal and hospitalised injuries in Pacific Island Countries has received scant attention. This study describes the development and piloting of a population-based trauma registry in Fiji to address this gap in knowledge.

METHODS

The Fiji Injury Surveillance in Hospitals (FISH) system was an active surveillance system designed to identify injuries resulting in death or a hospital admission in Viti Levu, Fiji. During the pilot conducted over five months in 2005, Accident and Emergency registers, admission folders and morgue registers from 8 of Viti Levu's 12 hospitals, and an additional 3 hospitals in other parts of the country were reviewed by hospital staff and medical students to identify cases and extract a minimum data set that included demographic factors; the mechanism, nature and context of injury; substance use; and discharge outcomes. The system was audited to identify and redress difficulties with data quality in a manner that also supported local capacity development and training in injury surveillance and data management.

RESULTS

This pilot study demonstrated the potential to collect high quality data on injuries that can pose a significant threat to life in Fiji using a mechanism that also increased the capability of health professionals to recognise the significance of injury as a public health issue.

CONCLUSION

The injury surveillance system piloted provides the opportunity to inform national injury control strategies in Fiji and increase the capacity for injury prevention and more focused research addressing risk factors in the local context.

Measuring the population burden of fatal and nonfatal injury

The value of measuring the population burden of fatal and nonfatal injury is well established. Population health metrics are important for assessing health status and health-related quality of life after injury and for integrating mortality, disability, and quality-of-life consequences. A frequently used population health metric is the disability-adjusted life-year. This metric was launched in 1996 in the original Global Burden of Disease and Injury study and has been widely adopted by countries and health development agencies alike to identify the relative magnitude of different health problems. Apart from its obvious advantages and wide adherence, a number of challenges are encountered when the disability-adjusted life-year is applied to injuries. Validation of disability-adjusted life-year estimates for injury has been largely absent. This paper provides an overview of methods and existing knowledge regarding the population burden of injury measurement. The review of studies that measured burden of injury shows that estimates of the population burden remain uncertain because of a weak epidemiologic foundation; limited information on incidence, outcomes, and duration of disability; and a range of methodological problems, including definition and selection of incident and fatal cases, choices in selection of assessment instruments and timings of use for nonfatal injury outcomes, and the underlying concepts of valuation of disability. Recommendations are given for methodological refinements to improve the validity and comparability of future burden of injury studies.

The relevance of WHO injury surveillance guidelines for evaluation: learning from the aboriginal community-centered injury surveillance system (ACCISS) and two institution-based systems

Background

Over the past three decades, the capacity to develop and implement injury surveillance systems (ISS) has grown worldwide and is reflected by the diversity of data gathering environments in which ISS operate. The capacity to evaluate ISS, however, is less advanced and existing evaluation guidelines are ambiguous. Furthermore, the applied relevance of these guidelines to evaluate ISS operating in various settings is unclear. The aim of this paper was to examine how the World Health Organization (WHO) injury surveillance guidelines have been applied to evaluate systems operating in three different contexts.

Methods

The attributes of a good surveillance system as well as instructions for conducting evaluations, outlined in the WHO injury surveillance guidelines, were used to develop an analytical framework. Using this framework, a comparative analysis of the application of the guidelines was conducted using; the Aboriginal Community-Centered Injury Surveillance System (ACCISS) from Canada, the Shantou-Emergency Department Injury Surveillance Project (S-EDISP) from China, and the Yorkhill-Canadian Hospitals Injury Reporting and Prevention Program (Y-CHIRPP) imported from Canada and implemented in Scotland.

Results

The WHO guidelines provide only a basic platform for evaluation. The guidelines over emphasize epidemiologic attributes and methods and under emphasize public health and injury prevention perspectives requiring adaptation for context-based relevance. Evaluation elements related to the dissemination and use of knowledge, acceptability, and the sustainability of ISS are notably inadequate. From a public health perspective, alternative reference points are required for re-conceptualizing evaluation paradigms. This paper offers an ISS evaluation template that considers how the WHO guidelines could be adapted and applied.

Conclusions

Findings suggest that attributes of a good surveillance system, when used as evaluation metrics, cannot be weighted equally across ISS. In addition, the attribute of acceptability likely holds more relevance than previously recognized and should be viewed as a critical underpinning attribute of ISS. Context-oriented evaluations sensitive to distinct operational environments are more likely to address knowledge gaps related to; understanding links between the production of injury data and its use, and the effectiveness, impact, and sustainability of ISS. Current frameworks are predisposed to disassociating epidemiologic approaches from subjective factors and social processes.

Modification of the home environment for the reduction of injuries

BACKGROUND

Injury in the home is common, accounting for approximately a third of all injuries. The majority of injuries to children under five and people aged 75 and older occur at home. Multifactorial injury prevention interventions have been shown to reduce injuries in the home. However, few studies have focused specifically on the impact of physical adaptations to the home environment and the effectiveness of such interventions needs to be ascertained.

OBJECTIVES

To determine the effect of modifications to the home environment on the reduction of injuries due to environmental hazards.

SEARCH STRATEGY

We searched The Cochrane Library, MEDLINE, EMBASE and other specialised databases. We also scanned conference proceedings and reference lists. We contacted the first author of all included randomised controlled trials. The searches were last updated to the end of December 2009, and were not restricted by language or publication status.

SELECTION CRITERIA

Randomised controlled trials.

DATA COLLECTION AND ANALYSIS

Two authors screened all abstracts for relevance, outcome and design. Two authors independently assessed methodological quality and extracted data from each eligible study. We performed meta-analysis to combine effect measures, using a random-effects model. We assessed heterogeneity using an I(2) statistic and a Chi(2) test.

MAIN RESULTS

We found 28 published studies and one unpublished study. Only two studies were sufficiently similar to allow pooling of data for statistical analyses. Studies were divided into three groups; children, older people and the general population/mixed age group. None of the studies focusing on children or older people demonstrated a reduction in injuries that were a direct result of environmental modification in the home. One study in older people demonstrated a reduction in falls and one a reduction in falls and injurious falls that may have been due to hazard reduction. One meta-analysis was performed which examined the effects on falls of multifactorial interventions consisting of home hazard assessment and modification, medication review, health and bone assessment and exercise (RR 1.09, 95% CI 0.97 to 1.23).

AUTHORS' CONCLUSIONS

There is insufficient evidence to determine whether interventions focused on modifying environmental home hazards reduce injuries. Further interventions to reduce hazards in the home should be evaluated by adequately designed randomised controlled trials measuring injury outcomes. Recruitment of large study samples to measure effect must be a major consideration for future trials. Researchers should also consider using factorial designs to allow the evaluation of individual components of multifactorial interventions.

Attendance for injury at accident and emergency departments in London: a cross-sectional study

OBJECTIVE

In order to set the foundation for the possible development of injury surveillance initiatives in north-west London, data on all presentations during 2002 at the nine accident and emergency departments (AEDs) in the relevant strategic health authority were examined.

STUDY DESIGN

Descriptive, cross-sectional study.

METHODS

A search algorithm was devised to extract records pertaining to injury presentations. The results were validated against a manually checked sample. Descriptive, quantitative analyses were performed.

RESULTS

Only four of the nine hospitals in the study area routinely recorded data in a form useful for research on injury. In these four hospitals, presentations with injury accounted for 29.7% of total attendances at the AED, which is markedly lower than the national average.

CONCLUSIONS

Certain characteristics of London regarding provision of primary care may explain why attendances for injury are proportionately low. However, the unusual pattern also underlines the importance of improving the quality of AED data in order to support adequate local surveillance of injury as the basis of efforts to prevent such incidents and to plan services to deal with injuries.

The UK burden of injury study - a protocol. [National Research Register number: M0044160889]

Background

Globally and nationally large numbers of people are injured each year, yet there is little information on the impact of these injuries on people's lives, on society and on health and social care services. Measurement of the burden of injuries is needed at a global, national and regional level to be able to inform injured people of the likely duration of impairment; to guide policy makers in investing in preventative measures; to facilitate the evaluation and cost effectiveness of interventions and to contribute to international efforts to more accurately assess the global burden of injuries.

Methods/Design

A prospective, longitudinal multi-centre study of 1333 injured individuals, atttending Emergency Departments or admitted to hospital in four UK areas: Swansea, Surrey, Bristol and Nottingham. Specified quotas of patients with defined injuries covering the whole spectrum will be recruited. Participants (or a proxy) will complete a baseline questionnaire regarding their injury and pre-injury quality of life. Follow up occurs at 1, 4, and 12 months post injury or until return to normal function within 12 months, with measures of health service utilisation, impairment, disability, and health related quality of life. National estimates of the burden of injuries will be calculated by extrapolation from the sample population to national and regional computerised hospital in-patient, emergency department and mortality data.

Discussion

This study will provide more detailed data on the national burden of injuries than has previously been available in any country and will contribute to international collaborative efforts to more accurately assess the global burden of injuries. The results will be used to advise policy makers on prioritisation of preventive measures, support the evaluation of interventions, and provide guidance on the likely impact and degree of impairment and disability following specific injuries.

Preventing fractures among older people living in institutional care: a pragmatic randomised double blind placebo controlled trial of vitamin D supplementation

INTRODUCTION

Osteoporotic fractures in older people are a major and increasing public health problem. We examined the effect of vitamin D supplementation on fracture rate in people living in sheltered accommodation.

METHODS

In a pragmatic double blind randomised controlled trial of 3 years duration, we examined 3,440 people (2,624 women and 816 men) living in residential or care home. We used four-monthly oral supplementation using 100,000 IU vitamin D(2) (ergocalciferol). As a main outcome measure, we used the incidence of first fracture using an intention to treat analysis. This was a multicentre study in 314 care homes or sheltered accommodation complexes in South Wales, UK.

RESULTS

The vitamin D and placebo groups had similar baseline characteristics. In intention-to-treat analysis, 205 first fractures occurred in the intervention group during a total of 2,846 person years of follow-up (7 fractures per 100 people per year of follow-up), with 218 first fractures in the control group over 2,860 person years of follow-up. The hazard ratio of 0.95 (95% confidence interval 0.79-1.15) for intervention compared to control was not statistically significant.

CONCLUSION

Supplementation with four-monthly 100,000 IU of oral vitamin D(2) is not sufficient to affect fracture incidence among older people living in institutional care.

Using local injury surveillance for community-based injury prevention: an analysis of Scandinavian WHO Safe Community and Canadian Safe Community Foundation programmes

Injury surveillance is widely recognized as a critical prerequisite for effective injury prevention, yet few studies have investigated its use by community-based injury prevention programmes. This study examined the extent to which local injury data were collected, documented, analysed, linked to injury prevention action and used for evaluation among WHO Safe Communities in Scandinavia (25 programmes) and the Canadian Safe Community Foundation (SCF) network (16 programmes). For each programme, a key informant with relevant local knowledge was selected to respond to an emailed questionnaire. The study demonstrates that community-based injury prevention programmes experience difficulties accessing and effectively utilizing local injury surveillance data. The findings suggest that the responding SCF programmes approach injury prevention more scientifically than the Scandinavian WHO-designated Safe Community programmes, by making greater use of injury surveillance for assessment, integration into prevention strategies and measures, and evaluation. Despite study limitations, such as the low response rate among Canadian programmes and a large number of non-responses to two questions, the results highlight the importance of, and need for, greater use of local injury surveillance.

Long term health outcomes after injury in working age adults: a systematic review

BACKGROUND

Estimating the contribution of non-fatal injury outcomes remains a considerable challenge and is one of the most difficult components of burden of disease analysis. The aim of this systematic review was to quantify the effect of being injured compared with not being injured on morbidity and health service use (HSU) in working age adults.

METHODS

Studies were selected that were population based, had long term health outcomes measured, included a non-injured comparison group, and related to working age adults. Meta-analysis was not attempted because of the heterogeneity between studies.

RESULTS

Nine studies met the inclusion criteria. In general, studies found an overall positive association between injury and increased HSU, exceeding that of the general population, which in some studies persisted for up to 50 years after injury. Disease outcome studies after injury were less consistent, with null findings reported.

CONCLUSION

Because of the limited injury types studied and heterogeneity between study outcome measures and follow up, there is insufficient published evidence on which to calculate population estimates of long term morbidity, where injury is a component cause. However, the review does suggest injured people have an increased risk of long term HSU that is not accounted for in current methods of quantifying injury burden.

Modification of the home environment for the reduction of injuries

BACKGROUND

Injury in the home is extremely common, accounting for around a third of all injuries. The majority of injuries of children under five and people aged 75 and over, occur at home. Multifactorial injury prevention interventions have been shown to reduce injuries in the home. However, few studies have focused specifically on the impact of physical adaptations to the home environment and the effectiveness of such interventions needs to be ascertained.

OBJECTIVES

To review the evidence for the effect on injuries of modification of the home environment with a primary focus on interventions to reduce physical hazards.

SEARCH STRATEGY

We searched The Cochrane Library, MEDLINE, EMBASE, National Research Register and other specialised databases. We also scanned conference proceedings and reference lists. In addition, we contacted experts and trialists in the field. The searches were not restricted by language or publication status. The searches were last updated in December 2004.

SELECTION CRITERIA

Randomised controlled trials.

DATA COLLECTION AND ANALYSIS

All abstracts were screened by two authors for relevance, outcome and design. Two authors independently assessed methodological quality and extracted data from each eligible study.

MAIN RESULTS

We found 18 published and one unpublished trials. Trials were not sufficiently similar to allow pooling of data by statistical analyses, so this review takes a narrative form. Studies were divided into three groups based on the primary population sample; children (five studies), older people (14 studies) and the general population/mixed age group (no studies). None of the studies focusing on children demonstrated a reduction in injuries that might have been due to environmental adaptation in the home; one study reported a reduction in injuries and in hazards but the two could not be linked. Of the 14 included studies in older people, none demonstrated a reduction in injuries due to hazard reduction, although two demonstrated a reduction in falls that could be due to hazard reduction.

AUTHORS' CONCLUSIONS

There is insufficient evidence to determine the effects of interventions to modify environmental home hazards. Further interventions to reduce hazards in the home should be evaluated by adequately designed randomised controlled trials measuring injury outcomes. Recruitment of large study samples to measure effect must be a major consideration for future trials.

Injuries in homes with certain built forms

BACKGROUND

Rates of injuries may occur more frequently in different types of homes.

METHODS

Retrospective population-based cohort study utilizing three linked databases: a population register, an architectural assessment of homes in the area, and an emergency department-based injury surveillance system.

RESULTS

Over 58,000 homes were classified into 94 different types according to age, size, and built form. Among the 112,248 inhabitants, there were 18,044 emergency department attendances for treatment of an injury suffered in the home. Adjusted odds ratio of injuries for residents of purpose-built apartments was substantially elevated for all injuries (2.07; 95% confidence interval [CI]=1.87-2.30) and poisoning episodes (5.6; 95% CI=3.8-8.3).

CONCLUSIONS

Residents of apartment buildings have substantially higher injury rates. Additional research is required to investigate the contribution of environmental hazards and behavioral factors underlying these high rates.

Gun-related eye injury in the United States, 1993-2002

OBJECTIVE

To present the descriptive epidemiology of gun-related eye injury in the United States from 1993 through 2002.

METHODS

Data from the National Electronic Injury Surveillance System was used to estimate the number of patients treated in the United States for gun-related eye injury (GEI) (air guns and firearms), air gun-related eye injury (AEI) (BB/pellet guns and rifles) and firearm-related eye injury (FEI) (all powder discharge guns) during the time period 1993 through 2002. Rates were calculated according to age, gender, race, weapon type and circumstances surrounding the injury event (e.g., locale and intent).

RESULTS

The rate of gun-related eye injury in the United States declined to 7.5 per 1,000,000 in 2002 from 14.8 per 1,000,000 in 1993, representing a decline of approximately 5.4% per year (p = 0.0002), due primarily to a decline in the rate of FEI (6.7% per year, p = 0.029). The rate of AEI was relatively constant. GEI rates were highest among those aged 10-19 years, males, and Blacks. The overall rate of AEI was higher than the rate of FEI (6.0 per 1,000,000 and 5.1 per 1,000,000, respectively). According to race, the rate of FEI was higher than the rate of AEI in Blacks whereas the rate of AEI was higher than the rate of FEI in Whites and Hispanics. The majority of GEIs occurred at home and were unintentional.

CONCLUSION

The rate of gun-related eye injury in the United States declined from 1993 through 2002 primarily due to a reduction in firearm-related eye injury, whereas the rate of air gun-related eye injury remained constant. Persons who were young, Black, and male were at highest risk for gun-related eye injury.

Is there value in using physician billing claims along with other administrative health care data to document the burden of adolescent injury? An exploratory investigation with comparison to self-reports in Ontario, Canada

BACKGROUND

Administrative health care databases may be particularly useful for injury surveillance, given that they are population-based, readily available, and relatively complete. Surveillance based on administrative data, though, is often restricted to injuries that result in hospitalization. Adding physician billing data to administrative data-based surveillance efforts may improve comprehensiveness, but the feasibility of such an approach has rarely been examined. It is also not clear how injury surveillance information obtained using administrative health care databases compares with that obtained using self-report surveys. This study explored the value of using physician billing data along with hospitalization data for the surveillance of adolescent injuries in Ontario, Canada. We aimed i) to document the burden of adolescent injury using administrative health care data, focusing on the relative contribution of physician billing information; and ii) to explore data quality issues by directly comparing adolescent injuries identified in administrative and self-report data.

METHODS

The sample included adolescents aged 12 to 19 years who participated in the 1996-1997 cross-sectional Ontario Health Survey, and whose survey responses were linked to administrative health care datasets (N = 2067). Descriptive analysis was used to document the burden of injuries as a proportion of all physician care by gender and location of care, and to examine the distribution of both administratively-defined and self-reported activity-limiting injuries according to demographic characteristics. Administratively-defined and self-reported injuries were also directly compared at the individual level.

RESULTS

Approximately 10% of physician care for the sample was identified as injury-related. While 18.8% of adolescents had self-reported injury in the previous year, 25.0% had documented administratively-defined injury. The distribution of injuries according to demographic characteristics was similar across data sources, but congruence was low at the individual level. Possible reasons for discrepancies between the data sources included recall errors in the survey data and errors in the physician billing data algorithm.

CONCLUSION

If further validated, physician billing data could be used along with hospital inpatient data to make an important and unique contribution to adolescent injury surveillance. The limitations inherent in different datasets highlight the need to continue rely on multiple information sources for complete injury surveillance information.

Home injuries and built form--methodological issues and developments in database linkage

Background

The aim of this body of research is to determine whether injuries in the home are more common in particular types of housing. Previous home injuries research has tended to focus on behaviours or the provision of safety equipment to families with young children. There has been little consideration of the physical environment. This study reports methodological developments in database linkage and analysis to improve researchers abilities to utilise large administrative and clinical databases to carry out health and health services research.

Methods

The study involved linking a database of home injuries obtained from an emergency department surveillance system with an external survey of all homes in an area and population denominators for home types derived from a health service administrative database. Analysis of injury incidence by housing type was adjusted for potential biases due to deprivation and distance to hospital. For non-injured individuals data confidentiality considerations required the deprivation and distance measures be imputed. The process of randomly imputing these variables and the testing of the validity of this approach is detailed.

Results

There were 14,081 first injuries in 112,248 residents living in 54,081 homes over a two-year period. The imputation method worked well with imputed and observed measures in the injured group being very similar. Re-randomisation and a repeated analysis gave identical results to the first analysis. One particular housing type had a substantially elevated odds ratio for injury occurrence, OR = 2.07 (95% CI: 1.87 to 2.30).

Conclusions

The method of data linkage, imputation and statistical analysis used provides a basis for improved analysis of database linkage studies.

A two-step medically based injury surveillance system--experiences from the Oslo injury register

This paper presents a two-step injury surveillance system. In the first step, limited data (a minimum data set) on all (or a representative sample of all) injuries to residents and non-residents within a defined geographical area were obtained using routine collection procedures within the medical care system. The second step involved periodically sampling of specific injuries, injured persons, or places for in-depth investigations from the database established by the first step, or selecting relevant injured persons seeking treatment in the medical care system, to collect many data (an expanded data set) on a limited number of injuries. This system was implemented in Oslo. Data from about 48,000 injuries were collected annually. Two in-depth investigations of serious occupational injuries were carried out. The first involved 223 cases and the second, 50 cases. Some in-site studies were included. Experiences from the implementation in Oslo suggest that this system can function in the medical care system and provide data required for making estimates of injury incidence rates, establishing trends, and on contributing factors to injuries. A crucial factor in the success of the first part of such a system is to have enough resources for continuous quality control and feedback to personnel involved in the registration of data. Combining the registered data from general practitioners, accident and emergency departments, hospitals and notifications of fatalities in Oslo, and on assessments of the number of injuries treated by private clinics and occupational health centres in Oslo, and in the health care system outside of Oslo, leads to the conclusion that 11.9% of the residents of Oslo will annually be treated for an injury.

The effect of socioeconomic deprivation on fracture incidence in the United Kingdom

Lifestyle factors such as diet and physical activity vary in different social and income groups, and are known to be important influences on the incidence of osteoporotic fractures. Financial and social pressures are a common concern for older people. We set out to study the effect of socioeconomic deprivation on the incidence of fracture in older people and to compare the findings with those for younger groups. The All Wales Injury Surveillance System (AWISS) is a computerized system that collects injury data from most A&E departments throughout Wales. In this population-based study of 1.8 million people living in the 445 electoral tracts covered by AWISS in south, west, and northeastern Wales, we identified all 60,106 residents who presented with a fracture in 1999 and 2000. We linked details of their fracture with published Townsend deprivation scores for the electoral tract in which they were living and calculated fracture rates by fifths of deprivation. We observed the expected pattern of increasing fracture incidence in older age groups. Fracture incidence was significantly higher in electoral wards with poorer Townsend scores, resulting from a marked effect of socioeconomic deprivation on fracture incidence among younger adults with a rate ratio of 1.64 (95% CI, 1.57 to 1.72). This effect diminished with age, and was not observed in older age groups. At ages 85 and over the rate ratio was 0.94 (95% CI, 0.87 to 1.01). Socioeconomic factors clearly play a part in the causation of fracture in younger adults. Lifestyle influences are important in older age groups, but socioeconomic deprivation does not appear to be a risk factor for the development of osteoporotic fractures in elderly people.

Effectiveness of rugby headgear in preventing soft tissue injuries to the head: a case-control and video cohort study

OBJECTIVE

To determine if headgear use by rugby players was associated with a reduced risk of head or facial laceration, abrasion, or fracture.

METHODS

An emergency department based case-control study in South Wales, UK, with cases being rugby players treated for superficial head and facial injuries and controls being their matched opponents during the game. A review of videos of the 41 games in the 1999 Rugby World Cup was also carried out to compare with the case-control study. Odds ratios (OR) and 95% confidence intervals (95% CI) were used to measure association between exposure (headgear wearing) and outcome (head and facial injuries).

RESULTS

In the case-control study, 164 pairs were analysed, with headgear worn by 12.8% of cases and 21.3% of controls. Headgear use was associated with substantial but non-significant reductions in superficial head (OR = 0.43, 95% CI 0.13 to 1.19) and facial (OR = 0.57, 95% CI 0.21 to 1.46) injuries. The video study followed 547 players over 41 games, during which there were 47 bleeding injuries to the head. Headgear use significantly reduced the risk of bleeding head injury in forwards (OR = 0.14, 95% CI 0.01 to 0.99, p = 0.02), but not in backs. There was also a higher risk of facial injury among forwards, but this was not significant.

CONCLUSIONS

The combined results suggest that headgear can prevent certain types of superficial head injuries in players at all levels of the game, but the evidence is strongest for superficial head injury in elite forwards. A randomised controlled trial would be the best way to study this further.

A pragmatic approach to timely disease surveillance in the emergency department

BACKGROUND

Computerised emergency department (ED) logs have been in use for more than 20 years. Despite this, public health authorities have failed to fully utilise this important surveillance tool.

SETTING

Alice Ho Miu Ling Nethersole Hospital (AHNH) is a 500 bed community hospital with ED attendance of 350-400 patients a day in Hong Kong.

INTERVENTION

After the introduction of an ED computerised management system across Hong Kong in 1997, AHNH monitored common presentations using standard statistical software. Deviations from average attendance frequency were reported to public authorities. Experience during 1999 and 2000 calendar years is reported.

RESULTS

Apart from the usual seasonal variation in presentations such as respiratory tract infection and gastroenteritis, specific public health interventions appeared warranted in presentations related to dog bites, bee stings, rubella, hand foot and mouth, chicken pox, and scooter injuries.

DISCUSSION

ED computer information systems should be an effective tool for disease surveillance. In communities where this is not the case, public health authorities should insist on timely access and reporting of ED attendance data.

Routine narrative analysis as a screening tool to improve data quality

AIM

To determine whether narrative information in emergency department surveillance systems can be systematically interrogated to improve our understanding of the causes of injury.

METHODS

Screening algorithms for location, intent, and activity were developed from structured analysis of narrative data from 98999 records. The algorithms were then tested on a 50000 record database containing entries in both of the two narrative fields. A proxy gold standard was defined as the total extract using both code and narrative. Sensitivity and specificity of the emergency department coding and narrative algorithms was calculated.

RESULTS

The proportion of records carrying an informative emergency department code was higher in records containing narrative-the percentage of causes coded "not know" dropped by 28.3%. The sensitivity of coded data varied from 42% to 98 % and from 33% to 99% for narrative data. Narrative analysis increased the percentage of home injuries identified by 19%, assaults by 26%, and rugby injuries by 137%.

CONCLUSIONS

Using a small amount of narrative is a practical and effective means of developing more informative injury causation data in an emergency department based surveillance system. It allows for internal validation of the codes and for the identification of emerging hazards without adding more "tick boxes" or further burdening data entry clerks.

Modification of the home environment for the reduction of injuries

BACKGROUND

Injury in the home is extremely common, accounting for around a third of all injuries. The majority of injuries of children under five and people aged 75 and over occur at home. Multi-factorial injury prevention interventions have been shown to reduce injuries in the home. However, few studies have focussed specifically on the impact of physical adaptations to the home environment and the effectiveness of such intervention needs to be ascertained.

OBJECTIVES

To review the evidence for the effect on injuries of modification of the home environment with a primary focus on interventions to reduce physical hazards.

SEARCH STRATEGY

We searched the following databases: APId, ASSIA, British Nursing Index, CINAHL, Cochrane Library databases, Dissertation Abstracts, EMBASE, HealthSTAR, ICONDA, ISI Science (and Social Science) Citation Index, MEDLINE, National Research Register, PREMEDLINE, SIGLE and Urbadisk. Conference proceedings and reference lists were scanned. Experts in the field and trialists were contacted. Searches were not restricted to English language. Handsearching of relevant journals was not conducted.

SELECTION CRITERIA

Randomised controlled trials, non-randomised controlled trials, controlled before-and-after studies and interrupted time series studies.

DATA COLLECTION AND ANALYSIS

All abstracts were screened by two reviewers for relevance, outcome and design. Two reviewers independently evaluated methodological quality and extracted data from each eligible study.

MAIN RESULTS

We found 28 published trials and one unpublished study. Trials were not sufficiently similar to allow for the combination of data by statistical analyses, so this review takes a narrative form. Studies were divided into three groups based on the primary population sample: children, older people and the general population. None of the 11 childhood studies demonstrated a reduction in injuries that might have been due to environmental adaptation in the home. One study reported a reduction in injuries and in hazards but the two could not be linked. The majority of studies used hazard reduction as the outcome. Of the 15 studies in older people, none demonstrated a reduction in injuries due to hazard reduction, although two demonstrated a reduction in falls that could be due to hazard reduction. In the mixed age group there were two trials; neither demonstrated an effect on injuries.

REVIEWER'S CONCLUSIONS

There is insufficient evidence to determine the effects of interventions to modify environmental home hazards. Further interventions to reduce hazards in the home should be evaluated by adequately designed randomised controlled trials measuring injury outcomes. Recruitment of large study samples to measure effect may be a major consideration for future trials.